Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy

Abstract

Objective. To describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6-23 months in 80 low and middle-income countries (LMICs). Methods. We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6-23 months included minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles) and absolute (estimated household income) socioeconomic indicators. Results. Only 21.3%, 56.2% and 10.1% of the 80 countries showed prevalence levels above 50% for MDD, MMF and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF in East Asia & the Pacific. Log per capita gross domestic product was positively associated with MDD (R2 = 48.5%), MMF (28.2%) and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the three indicators; pro-poor inequalities were observed in two countries for MMF, and in none for the other two indicators. Breastmilk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded about US$20,000. There were no consistent differences among boys and girls for any of the indicators studied. Conclusion. Monitoring complementary feeding indicators in the world and implementing policies and programs to reduce wealth related inequalities are essential to achieve optimal child nutrition.